Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA07.033f


Attachment:B

Policy #:MA07.033f

Description:ICD-10 Codes

Title:Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.


THE FOLLOWING CODES REPRESENT INDICATIONS THAT SUPPORT MEDICAL NECESSITY
ICD-10 Code Narrative
A05.1Botulism food poisoning
A35Other tetanus
B91Sequelae of poliomyelitis
C70.0Malignant neoplasm of cerebral meninges
C70.1Malignant neoplasm of spinal meninges
C70.9Malignant neoplasm of meninges, unspecified
C72.0Malignant neoplasm of spinal cord
C72.1Malignant neoplasm of cauda equina
C72.20Malignant neoplasm of unspecified olfactory nerve
C72.21Malignant neoplasm of right olfactory nerve
C72.22Malignant neoplasm of left olfactory nerve
C72.30Malignant neoplasm of unspecified optic nerve
C72.31Malignant neoplasm of right optic nerve
C72.32Malignant neoplasm of left optic nerve
C72.40Malignant neoplasm of unspecified acoustic nerve
C72.41Malignant neoplasm of right acoustic nerve
C72.42Malignant neoplasm of left acoustic nerve
C72.50Malignant neoplasm of unspecified cranial nerve
C72.59Malignant neoplasm of other cranial nerves
C72.9Malignant neoplasm of central nervous system, unspecified
C79.31Secondary malignant neoplasm of brain
C79.32Secondary malignant neoplasm of cerebral meninges
C79.40Secondary malignant neoplasm of unspecified part of nervous system
C79.49Secondary malignant neoplasm of other parts of nervous system
C79.51Secondary malignant neoplasm of bone
C79.52Secondary malignant neoplasm of bone marrow
D32.1Benign neoplasm of spinal meninges
D33.3Benign neoplasm of cranial nerves
D33.4Benign neoplasm of spinal cord
D33.7Benign neoplasm of other specified parts of central nervous system
D43.0Neoplasm of uncertain behavior of brain, supratentorial
D43.1Neoplasm of uncertain behavior of brain, infratentorial
D43.2Neoplasm of uncertain behavior of brain, unspecified
D43.4Neoplasm of uncertain behavior of spinal cord
D49.6Neoplasm of unspecified behavior of brain
E08.40Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified
E08.41Diabetes mellitus due to underlying condition with diabetic mononeuropathy
E08.42Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E08.43Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy
E08.44Diabetes mellitus due to underlying condition with diabetic amyotrophy
E08.49Diabetes mellitus due to underlying condition with other diabetic neurological complication
E08.610Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy
E09.40Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified
E09.41Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy
E09.42Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy
E09.43Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy
E09.44Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy
E09.49Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication
E09.610Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy
E10.40Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.41Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44Type 1 diabetes mellitus with diabetic amyotrophy
E10.49Type 1 diabetes mellitus with other diabetic neurological complication
E10.610Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E10.65Type 1 diabetes mellitus with hyperglycemia
E11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.41Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.44Type 2 diabetes mellitus with diabetic amyotrophy
E11.49Type 2 diabetes mellitus with other diabetic neurological complication
E11.610Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E11.65Type 2 diabetes mellitus with hyperglycemia
E13.40Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.41Other specified diabetes mellitus with diabetic mononeuropathy
E13.42Other specified diabetes mellitus with diabetic polyneuropathy
E13.43Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44Other specified diabetes mellitus with diabetic amyotrophy
E13.49Other specified diabetes mellitus with other diabetic neurological complication
E13.610Other specified diabetes mellitus with diabetic neuropathic arthropathy
E51.2Wernicke's encephalopathy
E51.8Other manifestations of thiamine deficiency
E51.9Thiamine deficiency, unspecified
E56.0Deficiency of vitamin E
E56.8Deficiency of other vitamins
E78.6Lipoprotein deficiency
G04.1Tropical spastic paraplegia
G11.0Congenital nonprogressive ataxia
G11.1Early-onset cerebellar ataxia
G11.2Late-onset cerebellar ataxia
G11.3Cerebellar ataxia with defective DNA repair
G11.4Hereditary spastic paraplegia
G11.8Other hereditary ataxias
G11.9Hereditary ataxia, unspecified
G12.0Infantile spinal muscular atrophy, type I [Werdnig-Hoffman]
G12.1Other inherited spinal muscular atrophy
G12.20Motor neuron disease, unspecified
G12.21Amyotrophic lateral sclerosis
G12.22Progressive bulbar palsy
G12.23Primary lateral sclerosis
G12.24Familial motor neuron disease
G12.25Progressive spinal muscle atrophy
G12.29Other motor neuron disease
G12.8Other spinal muscular atrophies and related syndromes
G12.9Spinal muscular atrophy, unspecified
G13.0Paraneoplastic neuromyopathy and neuropathy
G13.1Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G14Postpolio syndrome
G20Parkinson's disease
G21.4Vascular parkinsonism
G24.01Drug induced subacute dyskinesia
G24.02Drug induced acute dystonia
G24.09Other drug induced dystonia
G24.1Genetic torsion dystonia
G24.2Idiopathic nonfamilial dystonia
G24.3Spasmodic torticollis
G24.4Idiopathic orofacial dystonia
G24.5Blepharospasm
G24.8Other dystonia
G24.9Dystonia, unspecified
G25.3Myoclonus
G25.61Drug induced tics
G25.69Other tics of organic origin
G25.89Other specified extrapyramidal and movement disorders
G25.9Extrapyramidal and movement disorder, unspecified
G32.0Subacute combined degeneration of spinal cord in diseases classified elsewhere
G32.81Cerebellar ataxia in diseases classified elsewhere
G35Multiple sclerosis
G36.0Neuromyelitis optica [Devic]
G36.1Acute and subacute hemorrhagic leukoencephalitis [Hurst]
G36.8Other specified acute disseminated demyelination
G36.9Acute disseminated demyelination, unspecified
G37.0Diffuse sclerosis of central nervous system
G37.1Central demyelination of corpus callosum
G37.2Central pontine myelinolysis
G37.3Acute transverse myelitis in demyelinating disease of central nervous system
G37.4Subacute necrotizing myelitis of central nervous system
G37.5Concentric sclerosis [Balo] of central nervous system
G37.8Other specified demyelinating diseases of central nervous system
G37.9Demyelinating disease of central nervous system, unspecified
G50.0Trigeminal neuralgia
G50.1Atypical facial pain
G50.8Other disorders of trigeminal nerve
G50.9Disorder of trigeminal nerve, unspecified
G51.0Bell's palsy
G51.1Geniculate ganglionitis
G51.2Melkersson's syndrome
G51.31Clonic hemifacial spasm, right
G51.32Clonic hemifacial spasm, left
G51.33Clonic hemifacial spasm, bilateral
G51.39Clonic hemifacial spasm, unspecified
G51.4Facial myokymia
G51.8Other disorders of facial nerve
G51.9Disorder of facial nerve, unspecified
G52.0Disorders of olfactory nerve
G52.1Disorders of glossopharyngeal nerve
G52.2Disorders of vagus nerve
G52.3Disorders of hypoglossal nerve
G52.7Disorders of multiple cranial nerves
G52.8Disorders of other specified cranial nerves
G52.9Cranial nerve disorder, unspecified
G53Cranial nerve disorders in diseases classified elsewhere
G54.0Brachial plexus disorders
G54.1Lumbosacral plexus disorders
G54.2Cervical root disorders, not elsewhere classified
G54.3Thoracic root disorders, not elsewhere classified
G54.4Lumbosacral root disorders, not elsewhere classified
G54.5Neuralgic amyotrophy
G54.6Phantom limb syndrome with pain
G54.7Phantom limb syndrome without pain
G54.8Other nerve root and plexus disorders
G54.9Nerve root and plexus disorder, unspecified
G55Nerve root and plexus compressions in diseases classified elsewhere
G56.00Carpal tunnel syndrome, unspecified upper limb
G56.01Carpal tunnel syndrome, right upper limb
G56.02Carpal tunnel syndrome, left upper limb
G56.03Carpal tunnel syndrome, bilateral upper limbs
G56.10Other lesions of median nerve, unspecified upper limb
G56.11Other lesions of median nerve, right upper limb
G56.12Other lesions of median nerve, left upper limb
G56.13Other lesions of median nerve, bilateral upper limbs
G56.20Lesion of ulnar nerve, unspecified upper limb
G56.21Lesion of ulnar nerve, right upper limb
G56.22Lesion of ulnar nerve, left upper limb
G56.23Lesion of ulnar nerve, bilateral upper limbs
G56.30Lesion of radial nerve, unspecified upper limb
G56.31Lesion of radial nerve, right upper limb
G56.32Lesion of radial nerve, left upper limb
G56.33Lesion of radial nerve, bilateral upper limbs
G56.40Causalgia of unspecified upper limb
G56.41Causalgia of right upper limb
G56.42Causalgia of left upper limb
G56.43Causalgia of bilateral upper limbs
G56.80Other specified mononeuropathies of unspecified upper limb
G56.81Other specified mononeuropathies of right upper limb
G56.82Other specified mononeuropathies of left upper limb
G56.83Other specified mononeuropathies of bilateral upper limbs
G56.90Unspecified mononeuropathy of unspecified upper limb
G56.91Unspecified mononeuropathy of right upper limb
G56.92Unspecified mononeuropathy of left upper limb
G56.93Unspecified mononeuropathy of bilateral upper limbs
G57.00Lesion of sciatic nerve, unspecified lower limb
G57.01Lesion of sciatic nerve, right lower limb
G57.02Lesion of sciatic nerve, left lower limb
G57.03Lesion of sciatic nerve, bilateral lower limbs
G57.10Meralgia paresthetica, unspecified lower limb
G57.11Meralgia paresthetica, right lower limb
G57.12Meralgia paresthetica, left lower limb
G57.13Meralgia paresthetica, bilateral lower limbs
G57.20Lesion of femoral nerve, unspecified lower limb
G57.21Lesion of femoral nerve, right lower limb
G57.22Lesion of femoral nerve, left lower limb
G57.23Lesion of femoral nerve, bilateral lower limbs
G57.30Lesion of lateral popliteal nerve, unspecified lower limb
G57.31Lesion of lateral popliteal nerve, right lower limb
G57.32Lesion of lateral popliteal nerve, left lower limb
G57.33Lesion of lateral popliteal nerve, bilateral lower limbs
G57.40Lesion of medial popliteal nerve, unspecified lower limb
G57.41Lesion of medial popliteal nerve, right lower limb
G57.42Lesion of medial popliteal nerve, left lower limb
G57.43Lesion of medial popliteal nerve, bilateral lower limbs
G57.50Tarsal tunnel syndrome, unspecified lower limb
G57.51Tarsal tunnel syndrome, right lower limb
G57.52Tarsal tunnel syndrome, left lower limb
G57.53Tarsal tunnel syndrome, bilateral lower limbs
G57.60Lesion of plantar nerve, unspecified lower limb
G57.61Lesion of plantar nerve, right lower limb
G57.62Lesion of plantar nerve, left lower limb
G57.63Lesion of plantar nerve, bilateral lower limbs
G57.70Causalgia of unspecified lower limb
G57.71Causalgia of right lower limb
G57.72Causalgia of left lower limb
G57.73Causalgia of bilateral lower limbs
G57.80Other specified mononeuropathies of unspecified lower limb
G57.81Other specified mononeuropathies of right lower limb
G57.82Other specified mononeuropathies of left lower limb
G57.83Other specified mononeuropathies of bilateral lower limbs
G57.90Unspecified mononeuropathy of unspecified lower limb
G57.91Unspecified mononeuropathy of right lower limb
G57.92Unspecified mononeuropathy of left lower limb
G57.93Unspecified mononeuropathy of bilateral lower limbs
G58.0Intercostal neuropathy
G58.7Mononeuritis multiplex
G58.8Other specified mononeuropathies
G58.9Mononeuropathy, unspecified
G59Mononeuropathy in diseases classified elsewhere
G60.0Hereditary motor and sensory neuropathy
G60.1Refsum's disease
G60.2Neuropathy in association with hereditary ataxia
G60.3Idiopathic progressive neuropathy
G60.8Other hereditary and idiopathic neuropathies
G60.9Hereditary and idiopathic neuropathy, unspecified
G61.0Guillain-Barre syndrome
G61.1Serum neuropathy
G61.81Chronic inflammatory demyelinating polyneuritis
G61.82Multifocal motor neuropathy
G61.89Other inflammatory polyneuropathies



Version Effective Date: 10/01/2019
Version Issued Date: 10/01/2019
Version Reissued Date: 11/21/2019

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